10D2158938 CLIA NUMBER - PROSCAN NCH IMAGING, LLC

Laboratory Demographics

CLIA Number: 10D2158938

Facility Name: PROSCAN NCH IMAGING, LLC

Facility Address:
24040 S TAMIAMI TRAIL ATTN RADIOLOGY
BONITA SPRINGS, FL
ZIP 34134
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Facility Phone Number: 239 572-8649

Facility Type: Other - OUT PATIENT IMAGING CENTE

Certificate Type: Waiver

NPI Number: 1750972493

Taxonomy: 2085R0202X - Radiology
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

CLIA Record

Field Name	Field Value
CLIA Number	10D2158938
LAB Type	Other - OUT PATIENT IMAGING CENTE
Facility Name	PROSCAN NCH IMAGING, LLC
Street	24040 S TAMIAMI TRAIL ATTN RADIOLOGY
City	BONITA SPRINGS
State	FL
ZIP	34134
Phone	239 572-8649
CertificateType	4
CertificateEffectiveDate	12/11/2022
CertificateExpirationDate	12/10/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024